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The determination of moderate quantities of fluid within the pericardial cavity by physical diagnosis is too often indecisive. Even the roentgenologic diagnosis is by no means infallible. Of all the evidences that are conventionally employed, I have found that the conjunction of three signs is usually conclusive in determining the diagnosis of pericardial effusion; in the order of their importance, they are: (1) widening of the area of cardiac flatness, (2) abrupt transition from pulmonary resonance to cardiac flatness and (3) widening of the cardiac dulness in the second intercostal space. Of these three signs, only the second, so far as I can gather, has not been described before. No one of these signs, taken singly, is conclusive, but together they form a triad which is thoroughly reliable, as confirmed by roentgen examination or at autopsy.
The physical basis for these signs is obvious. The normal area of cardiac flatness
MOSCHCOWITZ E. A NEW SIGN OF PERICARDIAL EFFUSION. JAMA. 1933;100(21):1663–1664. doi:10.1001/jama.1933.02740210011004
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